23 empty rectum with a width under 3 cm if the child doesn’t need to poop. Has the treatment resulted in the anticipated effect? Has the defecation pattern changed, and faecal leakage stopped? If the leakage of faeces gets better but then comes back, there might be a relapse in constipation. Another round of evacuating the hard stool might be needed. This is not uncommon in patients. Is the toilet routine working? If the leakage does not stop despite aggressive treatment of constipation, there might be a need for transanal irrigation (TAI) for some time. By adding water rectally to the colon via an irrigation set daily or every other day, the bowel empties better, and a normal defecation pattern is supported. The patient has a better chance to be free from leakage of faeces or have an improvement. TAI is an invasive treatment that can be very distressing for some patients and parents but if they are bothered by the leakage, they are often more positive to give it a chance. Ending phase When the treatment has resulted in a period of at least 3-6 months of good bowel habits with daily pooping and no leakage, the treatment can be reduced slowly. If the child has started to poop by itself, the routines after meals can be skipped on those days. The macrogol dose can be lowered gradually, for example once a week by ¼ dose. Some families want to go even slower. If the child has TAI, the irrigation days can be reduced, and it is ok to use the irrigation more sporadically in the end.
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